{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:48:22Z","timestamp":1785739702040,"version":"3.56.0"},"reference-count":22,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Beijing Science and Technology Nova Program Interdisciplinary Project","award":["20230484439"],"award-info":[{"award-number":["20230484439"]}]},{"name":"Beijing High-Level Public Health Technical Talents Project","award":["2023-02-33"],"award-info":[{"award-number":["2023-02-33"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Severe Mycoplasma pneumoniae pneumonia (SMPP) presents with heterogeneous clinical complications and imaging manifestations, including pleural effusion (PE), bronchiolitis obliterans (BO), and distinct imaging\/bronchoscopic phenotypes. The precise systemic immune subpopulation dynamics underlying these distinct phenotypes remain poorly defined. Methods: We conducted flow cytometric profiling of peripheral blood mononuclear cells (PBMCs) from pediatric patients to compare mild MPP (MMPP-N) and severe MPP subtypes. SMPP patients were stratified into subgroups including those with BO (SMPP&amp;BO, n = 3), PE (SMPP&amp;PE), and three imaging\/bronchoscopic phenotypes: Group A (SMPP-GA, mucous plugs), Group B (SMPP-GB, mucosal necrosis), and Group C (SMPP-GC, diffuse bronchiolitis). Composite immune indices and multi-marker discriminant analysis were constructed for secondary analysis. Results: Comprehensive high-dimensional profiling suggested that a fundamental innate-adaptive immune rebalancing may represent a key pathophysiological axis in severe disease. Patients with PE exhibited massive CD16\u2212 monocyte expansion (Delta = 40.0%) coupled with CD8+ Teff collapse (Delta = \u22129.2%). Preliminary data also suggest BO may be marked by CD56\u2212CD11C+ monocyte depletion (Delta = \u221223.1%, n = 3), warranting further validation. Imaging subgroup profiling revealed that SMPP-GC featured major B-cell maturation alterations (HLADR+CD45RAhigh expansion and CD38+CD25low depletion). Composite indices including the Adaptive Exhaustion Score suggested discriminatory power (AUC = 0.90 for PE vs. uncomplicated SMPP). The Innate-Adaptive Ratio increased progressively with severity (Spearman rho = +0.40, p = 0.0002). Conclusions: SMPP is not immunologically uniform. Innate-adaptive rebalancing underlies complication-specific phenotypes: inflammatory monocyte mobilization with adaptive exhaustion is strongly associated with PE, whereas B-cell maturation alterations characterize diffuse bronchiolitis. These findings identify potential biomarker candidates for patient stratification, though small-cohort observations require extensive validation in larger prospective studies.<\/jats:p>","DOI":"10.3390\/diagnostics16152429","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:17:40Z","timestamp":1785737860000},"page":"2429","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High-Dimensional Immune Profiling Reveals Innate-Adaptive Rebalancing and Subpopulation Trajectories in Pediatric Severe Mycoplasma pneumoniae Pneumonia"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7806-5723","authenticated-orcid":false,"given":"Chen","family":"Shen","sequence":"first","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4894-1435","authenticated-orcid":false,"given":"Deze","family":"Li","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2571-2357","authenticated-orcid":false,"given":"Xiaotong","family":"Wang","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Sun","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiwen","family":"Zheng","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Chen","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ni","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunying","family":"Zhao","sequence":"additional","affiliation":[{"name":"National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1128\/CMR.00114-16","article-title":"Mycoplasma pneumoniae from the Respiratory Tract and Beyond","volume":"30","author":"Waites","year":"2017","journal-title":"Clin. 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